Page 762 - Clinical Small Animal Internal Medicine

730 Section 8 Neurologic Disease

your patient. It is perfectly appropriate to make a fool of history. Be sure to consider all five major kinds of lesions
VetBooks.ir yourself as you attempt to gain the cooperation needed in your differential diagnosis or a list of these with which
you are comfortable. My list includes malformation, injury,
from your patient. When you think about this, you are
asking this patient to perform movements never asked of
experience with the anatomic diagnosis together with the
it before. It is really remarkable how well most of them inflammation, neoplasia, and degeneration (MIIND). Your
cooperate. The reward will be as accurate an anatomic signalment and history will often lead to a presumptive
diagnosis as possible. clinical diagnosis. Further examination of the patient with
Examination of a patient with signs of a neurologic ancillary procedures must depend on your differential
disorder should include a review of the history, a com- diagnosis and what you consider to be the most likely
plete physical examination, a neurologic examination, clinical diagnosis. Many factors will be considered in this
and appropriate ancillary procedures. The purpose of selection, including the cost to the owner.
the neurologic examination is to determine the neuro- Be sure to record carefully all your observations from the
logic abnormalities and, based on that, the location of neurologic examination, and never rely on your memory.
the lesion or lesions in the nervous system responsible Many forms are available for recording your observations.
for causing these abnormalities. The location is the Some of these forms list in detail every possible response
anatomic diagnosis. The continual use of a routine system- that is present or absent, with numbers to estimate the level
atic procedure will provide you with the experience and of response. The considerable variation between individual
confidence to make an accurate anatomic diagnosis. patients of the same species makes the recording of the
The differential diagnosis must be based on the anatomic degree of a response less reliable and often misleading. I
diagnosis, and the order of significance of these disorders prefer a less time‐consuming form that is easier to follow
will depend on your evaluation of the signalment and and adaptable to all species. An example of this follows.

NEUROLOGIC EXAMINATION
PATIENT IDENTIFICATION: __________________________________________
SIGNALMENT:_______________________________________________________
HISTORY:____________________________________________________________
MENTAL STATUS:____________________________________________________
GAIT AND POSTURE:_________________________________________________
CRANIAL NERVES:
II and VII: Menace: OS OD
II and III: Pupil Size: OS OD
Light in OS: OS OD
Light in OD: OS OD
III: Strabismus
V: Atrophy of temporal/masseter muscles
VI, III and IV: Strabismus
VII and V: Palpebral reflex
VIII: Nystagmus
IX, X: Swallowing
XI: Atrophy of trapezius muscle
XII: Tongue movement/atrophy
SPINAL NERVE REFLEXES:
POSTURAL REACTIONS:
Patellar: L R
Hopping: LF RF LH RH
Flexor: LF RF LH RH
PAW REPLACEMENT: LF RF LH RH
PERINEAL:
NOCICEPTION:
OTHER:

ANATOMIC DIAGNOSIS:
DIFFERENTIAL DIAGNOSIS: